I have received a question from a colleague, a former LLLL, who currently
works with AIDS sufferers, including babies of women with AIDS, in a fairly
isolated rural area of Zimbabwe.
She has been working with two babies of mothers with AIDS, and has noticed a
similarity in the response of both babies since they have been fed by
bottle, and I wondered if anyone would have information on this.
The first baby was born in February, and was breastfed for the first 4 - 5
months of life, until his HIV-infected mother became too ill with TB to
breastfeed him. He was then fed diluted cow's milk with micronutrients and
did very badly, had little/no weight gain, was very thin "chesty." My friend
was able to source some powdered formula for him, and he was then fed
formula by cup. This is because the Ministry of Health guidelines for
replacement feeding state that bottles and teats are dangerous and any baby
who is not breastfeeding should be fed by cup. Once on formula the baby
caught up very quickly and doubled his weight. However, my friend still
didn't think he was "right" and wondered about the baby's need for sucking.
She was given a couple of bottles, and taught the village women who were by
now feeding the baby how to clean and sterilize the bottles, and the baby
has received formula by bottle/teat for the last month. Apparently the
difference in the baby since he has been able to suck is nothing short of
amazing. From being very listless and inactive within one month he has
learned to sit, crawl and is learning to stand.
The second baby is 4 months. He was born by C/section to a mother with
active AIDS and because of her weakened immune system she has had repeated
infections related to the C/section and she has not been breastfeeding at
all. This baby has been on formula by cup from the beginning. However, in
the last month he has also received the formula in a bottle, and my friend
says that the difference in this baby is also very noticeable. He was
"flat", but now he is much more active, has started rolling over, makes
eye-contact, and is "chatting" to his carers.
My friend says that the only difference in the care of these babies is that
they have been given bottles, when they had been fed by cup, and she thinks
that it is the sucking itself per se in the last month which has made the
difference in their behaviour. She asks if it is possible for babies to
have a kind of "infant depression" if they are not able to exercise their
strong need to suck.
I have to confess that I myself have had some misgivings about the lack of
sucking that babies of HIV+ mothers would suffer if fed replacements in
accordance with the UNAIDS HIV and infant feeding guidelines. The need for
babies to suck seems to be so strong. So we're not really talking about
formula here, but about the method of delivery. I said I would ask the
experts. So what do you think??
Pamela Morrison IBCLC
Harare, Zimbabwe
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